- A new study finds a link between eating less whole fruit and conditions such as high blood pressure, cholesterol, and heart disease.
- One reason for this may be that the fiber and natural compounds in whole fruit may help lower cholesterol and blood sugar, which are lost during juicing.
- However, experts warn against labeling fruit juice or eating less fruit as a definitive cause of heart disease, and urge people to follow a healthy, whole-food diet and favor 100% fruit juice in moderation.
In one of the largest studies to compare whole fruit and 100% fruit juice intake and their links to heart health, new research suggests there may be an association between eating less whole fruit and conditions such as high blood pressure, high cholesterol, heart disease, or heart attack.
The study, published in Current Developments in Nutrition, used
The researchers’ findings on fruit juice, however, varied. People with high cholesterol consumed lower amounts on average, while people who experienced a prior heart attack had a higher intake of juice. There was no clear pattern for people with high blood pressure or a history of stroke.
On average, the survey participants ate whole fruit 1.06 times per day, while they drank juice about 0.3 times a day.
Commenting on the study findings, Rab Nawaz, MD, a neurologist and stroke physician, who was not involved in the study, said they “(fit) with existing knowledge about the benefits of fiber-rich foods, although the study cannot prove that eating more fruit prevents heart disease.”
Meanwhile, Jennifer Pallian, RD, BSc in Food, Nutrition and Health, who was also not involved in the study, agreed, saying she did not find the results particularly surprising.
“For example, a large prospective study involving more than 450,000 adults in China found that those who ate fresh fruit daily had a 40% lower risk of cardiovascular death and a 34% lower risk of major coronary events compared with those who rarely or never ate fresh fruit,” Pallian told Medical News Today.
“What I found particularly interesting about the current study was that the relationship between juice consumption and cardiovascular health was less consistent. After accounting for age, education, income, and smoking, significant differences in juice consumption frequency remained only for high cholesterol and heart attack,” she added.
Whole fruit vs fruit juice
During the process of juicing, a lot of the fiber from the pulp of the fruit is lost. Research has shown that fiber supports both
However, most Americans — almost 90% of the population — do not meet the recommended vegetable and fruit intake set by the current dietary guidelines for a healthy, balanced diet. On a 2,000-calorie diet, the guidelines advise eating about 2 cups’ worth of fruit per day.
Whole fruit also contains certain polyphenols and nutrients in more concentrated levels.
However, evidence so far has been a little mixed on fruit juice, with some studies suggesting that when consumed in moderation, it can offer health benefits.
Previous studies have also suggested differences in cardiovascular risk and fruit juice consumption. A large Dutch study found that moderate consumption of 100% fruit juice, which was defined as up to 7 small glasses per week, was associated with a significantly reduced risk of cardiovascular disease and coronary heart disease.
Recommendations for fruit or juice consumption may vary by age, health status, and dietary needs, such as people with diabetes, so a one-size-fits-all approach may not be best.
A study found that drinking one standard serving of 100% juice a day — of about 6 to 8 ounces — was linked to a small increase in BMI (body mass index) in younger children ages 1-6, but no such link was found for children ages 7–18 years.
“Although these findings don’t establish causation, they provide compelling evidence of an association between fresh fruit consumption and cardiovascular health.”
—Jennifer Pallian, RD
In what ways does whole fruit offer more health benefits than juice?
“One of the biggest advantages of whole fruit is its dietary fiber content, much of which is lost during juicing. For example, one cup of orange segments contains 3.6 grams of fiber, compared with just 0.5 grams in one cup of 100% orange juice,” Pallian said.
On how fiber can contribute to heart health and in particular managing cholesterol and blood pressure, she explained:
“Fiber is particularly important for heart health because soluble fiber can help lower LDL cholesterol by binding to bile salts in the digestive tract and increasing their excretion. Fiber may also help maintain healthy blood pressure, reduce inflammation, and support weight management, all of which can influence cardiovascular risk.”
“Whole fruits also encourage fullness and contain beneficial plant compounds that support blood vessel health. While 100% fruit juice provides vitamins and minerals, whole fruit is generally the best everyday choice,” Nawaz added.
“This suggests that the physical structure of fruit, including its intact cell walls and the chewing required to eat it, plays an important role in satiety. By helping people feel fuller, whole fruit may support weight management, which is another important consideration for heart health.”
—Jennifer Pallian, RD
Pallian also highlighted that whole fruits contain special nutrients called nonextractable polyphenols (NEPP), which are bound to fiber that travel to the colon, where healthy gut bacteria break them down into beneficial compounds.
These compounds support heart health by lowering cholesterol, reducing blood pressure, and preventing harmful fat buildup in blood vessels.
However, Pallian also cautioned against demonizing 100% fruit juice, with no added sugars or fillers.
“That said, juice still offers nutritional benefits. Certain carotenoids and polyphenols may be more readily available for absorption from juice than whole fruit, and previous (research) suggests that consuming up to 200 mL (milliliters) of juice may provide some cardiovascular benefits,” she noted.
What the study cannot provide
The study was observational and cross-sectional, meaning it captured only a specific point in time and did not track participants longitudinally over months or years.
“As a result, they couldn’t determine whether eating less fruit contributed to cardiovascular disease or whether people changed their eating habits after being diagnosed. The study also measured how frequently participants consumed fruit and juice rather than how much they consumed, making it impossible to compare cardiovascular outcomes across different levels of intake,” Pallian said.
The benefits the participants experienced were also self-reported, so the findings showed association, not causation. Therefore, the findings do not prove that eating less fruit causes heart disease.
Pallian explained that, by nature, self-reports can be affected by inaccurate recall or confusion, especially when reporting on 100% fruit juice intake vs. sugar-sweetened fruity beverages. She also pointed out that the study participants weren’t representative of the overall US population, which limits their applicability.
“Other factors, including exercise, body weight, and overall dietary patterns, could also influence the results. We also cannot determine whether participants changed their eating habits after developing cardiovascular problems,” Nawaz added.
Nawaz gave some practical advice for getting over the texture of fruit while still consuming it in ways that preserve their nutrients:
“I recommend trying smoothies made with whole fruit rather than strained juice because blending retains much of the fiber. Unsweetened applesauce, mashed bananas, soft berries, and cooked fruits are other practical options. The goal is to make fruit consumption comfortable and sustainable without unnecessarily losing its nutritional benefits.”
“Ultimately, smoothies made by blending the entire edible portion of the fruit may offer a practical middle ground for people who find whole fruit textures difficult. They provide a more manageable consistency while retaining more fiber than juice,” Pallian said.
However, she pointed out that smoothies aren’t nutritionally equivalent to eating whole fruit.
“In one study comparing whole apples, applesauce, and apple juice, whole apples were more filling than either applesauce or juice. This suggests that the structure of whole fruit and the chewing involved in eating it may provide additional benefits for appetite regulation, which could help with weight management, an important factor in heart health,” she told us.
On the topic of choosing healthier fruit juice options, Nawaz said 100% fruit juice without added sugar was best and, ideally, portions should be kept moderate at around 4 ounces.
“Previous research discussed in the primary article suggests that consuming up to 200 mL of juice may offer some cardiovascular benefits. However, because juicing removes most of the fiber, juice shouldn’t be considered nutritionally equivalent to whole fruit,” Pallian explained.
